Patricia B. Howard

Consumer perspectives on quality of inpatient mental health services

This study, conducted at two public-sector psychiatric hospitals in a south-eastern state, investigated satisfaction with inpatient services and treatment outcomes among 204 hospitalized mental health consumers. A simple survey design with nonrandom sampling technique was used; instruments included the KY-CSI, the 21-item MHSIP Consumer Survey, and the CSQ-8. Respondents reported satisfaction with time available to be with other patients, staff availability, and their degree of comfort talking to staff. Areas of dissatisfaction included lack of client input into treatment planning, lack of family involvement, and lack of medication education. Providers are encouraged to include clients in all phases of treatment planning and to continue to evaluate consumer perspectives of quality services.

Comorbid medical illnesses and perceived general health among adult recipients of Medicaid Mental Health Services.

The purpose of this retrospective, cross-sectional, descriptive study was to measure self-reported frequencies of medical problems, overall health, and health-related quality of life among mental health consumers. The sample included 787 adults who had received a mental health service paid for by Medicaid over a one-year period. The self-administered questionnaire included the 12-item Medical Outcomes Study (MOS) Short-Form (SF) Physical and Mental Health Summary Scales, and items about physical health problems and health-related quality of life. The majority of respondents (83.3%) reported that their general health was poor or fair. Frequently reported medical problems included arthritis, migraines, and high blood pressure. Knowledge of physical problems in persons with mental illness is essential for advanced practice nurses.

Quality Indicators for Primary Mental Health Within Managed Care: A Public Health Focus

Primary mental health is an orientation to care that addresses mental health needs of consumers on point of first contact with caregivers. Core values, and principles drawn from a public health perspective serve as the foundation for indicators of quality within managed primary mental health. A model, illustrating the key components for quality indicators, includes stakeholder groups (consumers, families, providers, and payers), quality concerns (access, appropriateness, outcomes, and prevention), and the spectrum of clinical processes (assessment, treatment, rehabilitation, and support). Responsibility for monitoring quality is vested in these stakeholder groups. To enable them to fulfill their responsibilities, indicators are proposed in the form of checklists. The checklists assist stakeholders in evaluating the plans and services offered by managed care entities.

Advanced practice psychiatric nursing: A national profile

The results of a national survey of Advanced Practice Psychiatric Nurses (APPN) are presented. Results are based on the Society for Education and Research in Psychiatric/Mental Health Nursings (SERPN) Primary Mental Health and Advanced Practice Psychiatric Nursing monograph. Characteristics of the nurses, the clients they serve, and their practice patterns are described. Documenting the cost-effectiveness of these practitioners and increasing the number of younger APPNs is recommended.

Training consumers to collect data in mental health service system evaluation research.

Consumer satisfaction with services is an outcome measure. This report describes The Consumer Satisfaction Research Associate Training Program, which was designed for the education and supervision of recovered consumers who collected data during four studies at three psychiatric hospitals. The educational program had didactic and laboratory components. Consumer research associates collected quantitative and qualitative data using a survey tool for face-to-face interviews. Participant recruitment and management of confidential records were included in the role. Data collected by research associates from consumers who are in treatment can enhance the validity and trustworthiness of satisfaction surveys. Nurses can play an important role in the research process by serving as staff resources for consumers who collect data in various service system settings.

Medical and Psychiatric Comorbidities in Children and Adolescents: A Guide to Issues and Treatment Approaches

Chronic medical illness among children and adolescents is a growing concern with implications for informal and formal caregivers. When coupled with a psychiatric comorbidity, implications grow exponentially. Nurses who care for child and adolescent populations play a crucial role in optimizing physical and mental health when they interface with patients and their caregivers. Evidence-based interventions can promote positive outcomes and enhance quality of life, whereas failure to use evidence-based approaches has serious consequences to the health of youth with medical and psychiatric comorbidities.

Scales to Evaluate Quality of Medication Management: Development and Psychometric Properties

This paper describes the psychometric properties of two fidelity scales created as part of the Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored medication management toolkit and their metric properties when used in 26 public mental health clinics with 50 prescribers. A 23-item scale, based on chart reviews, was developed to assess whether prescribers are following good medication practices, in conjunction with a 17-item scale to assess organizational support for and evaluation of prescriber adherence to recommended medication-related practices. Fundamental gaps in routine practice, including poor documentation of medication history and infrequent monitoring of symptoms and side effects were found.

Health Behavior Decision-making in African-American Adults Diagnosed with Schizophrenia.

Little is known about the factors that influence health behavior decision-making among people with schizophrenia. The purpose of this qualitative study was to describe the processes used by 10 African-American adults with schizophrenia when making health behavior decisions and identification of perceived barriers and facilitators to health. Three phases of health behavior decision-making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. Findings may guide clinicians’ efforts to improve the health status of patients, as well as influence future research in understanding health behavior decision-making among vulnerable populations.

Challenges of Implementing a Medication Management Evidence-Based Practice in a Community Mental Health Setting: Results of a Qualitative Study

The Medication Management Approaches in Psychiatry (MedMAP) is a medication management evidence-based practice (EBP) to guide the use of psychotropic medications in the treatment of schizophrenia. This qualitative study examined facilitators and barriers to implementing MedMAP in community mental health treatment settings. Audio-taped qualitative interviews were conducted with practitioners and administrators involved in a MedMAP implementation project conducted in six community mental health centers. Data analysis was conducted using thematic analysis of transcribed interviews. Findings indicate that facilitators to MedMAP implementation included practitioner recognition of the value of MedMAP, consumer involvement, collaboration, continuity of care, and fidelity assessments. Barriers to MedMAP implementation included problematic technology, work flow issues, lack of flexibility in prescribers’ ability to implement MedMAP guidelines, regulatory and financial barriers, and consumer insurance status. Recommendations for improving future implementation efforts of MedMAP emphasize technological readiness, development of innovative models of care delivery, an emphasis on treatment guided by outcomes, and active leadership to promote EBPs within organizations and academic settings.

The leadership role of nurse educators in mental health nursing.

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.